Chapter 19

Procedures that Utilize Nonaseptic Technique

- Nasogastic tubes

- Urinals

- Bedpans

- Enemas

- Colostomies

Nasogastric Tubes

- Also called NG tube

- Plastic or rubber tube inserted through the nasopharynx into the stomach

- Topical anesthetic is used on the throat during placement of NG tube

- NG tube is usually taped in place on the face; care must be taken to prevent accidental displacement of tube

Reasons for NG tube placement

- Administration of medications

- Gastric decompression

- Removal of flatus and fluids from stomach after intestinal obstruction or trauma

- Short-term Enteral feeding

Most common type of NG tube

- Levin tube

- Small caliber tube to allow for transnasal passage

- Has a single lumen with several holes near its tip

Male Urinal

- made of plastic and shaped to be used by a patient in various positions

- Patient may be able to help himself with urinal with the HCP offering privacy and minimal assistance

Urinal Extensive Assistance

Procedure

- Put on glovesRaise sheet to permit visibility

- Place urinal between patient's legs and place the penis into urinal so that it doesn't slip out.

- Hold urinal in place by the handle until patient finishes voiding- Remove urinal, empty it into commode, remove gloves, and wash hands

- Check with nurse to see if you need to measure the amount of urine they have, or if they need a urine sample

Bedpans

- Utilized for male patients who are not ambulatory for defecation or for female patients who need to urinate or defecate

- Made of plastic, disposable

- Usually about 2" high

Fracture Bedpans

- Utilized for patients who has a fracture or other disability - broken hip or pelvis

- Are shallower and contoured for patient comfort

- Usually have a handle that allows for easier placement and removal

- Have a plastic guard/edge that helps prevent spills

Bedpans Procedure

- If patient can assist, ask him/her to raise hips for bedpan placement

- Place pan under hips, centering it properly

- If the head of the bed/stretcher can be raised slightly, this will make urination or defecation easier for patient

- Give patient as much privacy as possible

- When patient is finished, assist with cleaning the perineal area with toilet paper, wipes or cloths

- Put on gloves to remove pan from under patient

- Remove pan, empty it into commode

- This process is much easier on the patient if two HCPs are available to assist

Bedpan Alternate Procedure

- Two HCPs assist patient

- Patient is rolled to one side while the other HCP places bedpan, then patient is rolled onto bedpan

- All other steps are the same

Ways the Colon is imaged

- Colonoscopy

- Virtual colonoscopy - performed in CT

- Sigmoidoscopy

- Barium enema

Bowel Preparation for Colon Imaging

- Dietary restrictions

- Purgation

- Hydration

- Cleansing enemas

Dietary Restrictions for Colon Imaging

- Usually a liquid or near liquid diet

- Designed to reduce frequency and volume of stools

- Low-residue diet Restriction of milk and milk products

- Restriction of fruits and vegetables

Purgation Step for Colon Imaging

- Uses a variety of laxatives

- Stool softener and a laxative

Hydration Step for Colon Imaging

Designed to:

- Be absorbed by the body and reduce stimulation of digestive system

- Maintain vital body fluid, salts and minerals

- Provide energy

- Clear liquid diet for 24 hours before procedure

- Carbonated beverages

- Clear gelatin

- Clear broth

- Coffee w/o milk or tea

Cleansing Enemals

- Commonly used to relieve severe constipation

- Utilizes a variety of solutions

- Tap water

- Saline solution

- Hypertonic solution

- Soap suds solution

Colon Prep for Diabetic Patients

Diabetic low-calorie drinks may be added to the prep

Insulin-dependent patients forgo normal insulin dose until after procedure

Reasons for a Barium Enema

- Diverticular disease - Diverticulitis (inflammation of the polyps) and Diverticulosis (polyps in colon)

- Inflammatory bowel disease

- Colon cancer screening

- Incomplete colonoscopy

- Distal intestinal obstruction

- Evaluation of questionable findings on other imaging procedures

- Polyps

Contrast for Barium Enema

Barium sulfate

Barium Sulfate

is the contrast most commonly used to examine esophagus, stomach, and intestine when a bowel perforation is not suspected

When bowel perforation is suspected

*water-soluble iodine compounds are the acceptable contrast medium; Gastrografin (diatrizoic acid compound)*

Bowel Perforation

A hole in the abdominal cavity, such as by an ulcer, a surgical procedure, etc.

Two Types of Barium Enemas

- Single Contrast

- Double Contrast

Single Contrast BE

barium is introduced into the colon

Double Contrast BE

thicker barium sulfate is introduced into colon, followed by air that will push barium through the colon; allows the barium to coat the surfaces of the colon

Barium Enema Administration

Barium is mixed in an enema bag attached to tubing with an enema tip on the end

Types of Enema Tips

- Plain Tip

- Balloon Tip

Plain Tip Enema Tip

has holes in the end to allow barium to flow into large intestine

Balloon Tip Enema Tip

tip has holes in end and also has an inflatable tip to hold the catheter in place and prevent involuntary expulsion of barium and the enema tip

Enema Tip Insertion

- Explain procedure to patient

- Enema solution is prepared. Suspend barium bag and fill tubing with barium to remove air

- *Have patient lie on left side with right knee in front of left knee with knee flexed (Sim’s position)*

- Put on gloves

- Coat the enema tip with water-soluble lubricant

- Instruct patient on importance of keeping tip in rectum. Have patient take slow, deep breaths before tip insertion

- Lift right buttock with heel of your hand to expose anus. On the patient’s exhale, insert the tip gently into anal orifice and direct anteriorly 1-1.5”.

- Depth should not exceed 1.5”

After Enema Tip Insertion

- Either tape tube in place or inflate balloon tip to hold tip in place

- Make sure clamp is on the tubing to prevent barium from passing into colon

- Patient may lie on their back while waiting for radiologist

Barium Enema Procedure

- Enema bag should not be placed more that 24" (60cm) above the radiographic table

- 2.5 cm = 1 inch

- Notify the radiologist that the patient is ready

- The radiologist will direct the flow of barium into the colon during the examination

- Radiologist takes images during the filling of the colon and the technologist will take images after the colon is filled

- Once procedure is complete, the excess barium is drained back into the enema bag that is placed on floor

- Remove tip; if balloon tip was used, deflate balloon prior to removing tip

- Assist patient to the restroom to evacuate the remaining barium

- Post-evacuation image is taken

Post Barium Enema Procedure

- can cause fecal impaction or intestinal obstruction

- Patient is instructed to increase fluid intake and dietary fiber for several days

- Some physicians recommend laxatives following this procedure

Stoma

opening from the bowel to the outside of the body

Colostomy Care

- Surgically formed because of trauma, cancer, diverticulitis or ulcerative colitis

- When patient has a portion of colon removed, a permanent colostomy is performed

Colostomy Patient

- An ostomy can affect a patient's self-image and cause him/her to become very self-conscious

- HCPs must be sensitive to this and provide ostomy care with technical competence and without evidence of revulsion

Colostomy Prep for Barium Enema

- Stoma is irrigated the night before and the morning of the examination

- Dietary and laxative prep varies depending on the ostomy

- Instructions are provided by referring physician

- Patients are instructed to bring and extra colostomy pouch with them for post-examination

Barium Enema through an Ostomy Steps

- Put on gloves

- Remove stoma dressing or colostomy pouch

- Change gloves before continuing procedure; put on new gloves

- A cone-shaped or nipple colostomy tip, or a small catheter with an inflatable cuff may be used to introduce the barium

- Technologist lubricates tip and hands it to radiologist for insertion; tape in place after insertion

- Barium is introduced according to the radiologist direction

- Radiologist takes images during exam, technologists take images after filling

- Once exam is complete, excess barium is drained back into bag, tip removed, patient assisted to bathroom and post-evacuation image taken.

- Patient is given post-procedural instructions by referring physician

ascultation

is listening to the internal sounds of the body, usually using a stethoscope, such as heart, lungs, and the gastrointestinal system

Barium

bulky, fine white powder, without odor or taste and free from grittiness; used as a contrast medium in radiography of the digestive tract

Bedpan

a vessel for receiving the urinary and fecal discharges of a patient unable to leave their bed

Colitis

inflammation of the lining of the colon

Colonoscopy

endoscopic examination of the large bowel and the distal part of the small bowel with a charge-coupled device camera or a fiberoptic camera on a flexible tube passed through the anus. Biopsies can be performed during the procedure. Excellent method to identify small polyps or masses

Colostomy

surgical creation of an opening between the colon and the surface of the body; also used to refer to the opening, or stoma, that is created

Defecation

evacuation of fecal material from the intestines

Emesis Basin

a kidney-shaped vessel for the collection of vomitus

Enema

liquid injected or to be injected into the rectum

Enterostomal Therapist

a health professional (usually a nurse) with special training and certification in the care of ostomies and related concerns

Flatus

gas or air evacuated through the anus

Fowler Position

position in which the patient's head is raised 18 or 20 inches above the flat position; the knees are also raised

Hydration

the term used to indicate that a liquid substance contains water

Loopogram

the radiographic evaluation of the small and large bowel that has been connected to the skin surface as a substitute for the urinary bladder with an ostomy

Low-Residue Diet

diet that gives the least possible fecal residue, such as gelatin, sucrose, dextrans, broth, and rice

Lumen

cavity or channel within a tube or tubular organ (plural, lumina)

Nasogastric (NG) Tube

tubes of soft rubber or plastic inserted through a nostril and into the stomach; for instilling liquid foods or other substances or for withdrawing gastric contents

Ostomate

one who has undergone enterostomy or ureterostomy

Perineum

region between the thighs, bound in the male by the scrotum and anus in and in the female by the vulva and anus

Purgation

catharsis; relief of fecal matter affected by a cathartic

Sigmoidoscopy

procedure used to see inside the sigmoid colon and rectum with a flexible tube that has a camera on the end (sigmoidoscope) and is placed through the anus

Sim's Position

position in which the patient lies on the left side with the right knee and thigh flexed and the left arm parallel along the back

Stoma

an opening established in the abdominal wall by colostomy, ileostomy, and so forth

Urinal

vessel or other receptacle for urine (male and female types)

Virtual Colonoscopy

it is performed on a multi-slice computed tomography scanner that takes up to 600 two-dimensional and three-dimensional images of the colon in approximately 30 seconds

Viscosity

a physical property of liquids that determines the internal resistance to shear forces

Barium Enema through an Ostomy

this procedure is called a loopogram